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0003 LARCH LANE
� _ � � � �. 1 �~` ,:� �� - - --_ - - -- -�-- -�V__�_ TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION //- -7 Map 99 Parcel Application # ` l� Health Division Date Issued Conservation Division '� Application F Planning Dept. Permit Fee Date Definitive Plan Approved by Planning Board Historic - OKH _ Preservation/ Hyannisr»liL Project Street Address Village Cente,-yi U-P dN ck_S. Owner KM � Address Telephone -q l D `" 9 //� Permit Request /v cS'7�e IJIN ,o// t loGeck MiAi Ctmb-1 Lelve Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay ` Project Valuatiori ��� Construction Type Lot Size 2z Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family hd Two Family ❑ Multi-Family(# units) Age of Existing Structure Historic House: ❑Yes ❑ No On Old King's Highway: ❑Yes ❑ No Basement Type: ❑ Full ❑ Crawl ❑Walkout ❑ Other Basement Finished Area (sq.ft.) Basement Unfinished Area (sq.ft) Number of Baths: Full: existing new Half: existing new Number of Bedrooms: existing _new Total Room Count (not including baths): existing new First Floor Room Count Heat Type and Fuel: ❑ Gas ❑ Oil ❑ Electric ❑ Other Central Air: ❑Yes ❑ No Fireplaces: Existing New Existing wood/coal stove: ❑Yes ❑ No Detached garage: ❑ existing ❑ new size—Pool: ❑ existing ❑ new size _ Barn: ❑ existing ❑ new size_ Attached garage: ❑ existing ❑ new size _Shed: ❑ existing ❑ new size _ Other: Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ 0 c Commercial ❑Yes ❑ No If yes, site plan review# cry Current Use Proposed Use r— m APPLICANT INFORMATION (BUILDER OR HOMEOWNER) Name Telephone Number Address 322 License # &CisT5, Home Improvement Contractor# Email 1 I'+ e CCY' i AXt Worker's Compensation # ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BETAKEN TO SIGNATURE DATE _ � FOR OFFICIAL USE ONLY APPLICATION # DATE ISSUED MAP/ PARCEL NO. ADDRESS VILLAGE OWNER DATE OF INSPECTION: FOUNDATION FRAME INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS: ROUGH FINAL FINAL BUILDING DATE CLOSED OUT ASSOCIATION PLAN NO. 27w CommompeaIth ofMassadrrsdJs Deparhfferzt&f1ndrrs&id Accidarats — Off—we a0M. -W- ti9atians _ 60.0 WasT hWoxt Street Baston,MA 02111 lop m- mas&gorldia WM.1mrs' Camrpensatsan Insurance Affit Bmtdez-dCant ractursMecfricians/Phimbers A 3PUMMt Please Pz int Le. t✓It yf f3te1 1 F Phone:iwk Are you an employer?Check the appropriate bow T of project r I.�am a 1 With 4 ❑I am a general contractor and I [: e ] { ���= �P� � 6. ❑1�Tew oonsasx employees(hall andfor part-time,* have hired the sub-coahmctors 2.❑ I am a sale prqpdetor or pastier- listed on the attached sheet:` I ❑Remodeling slip and have no employees These sub•-contractars.have 8. 0 Demolition wa l-ing for mein any capacity- enTloyees and have s wodmrs' 9. ❑B�ui1d"mg addition [No o6mrs' camp.insurance comp-Rtsurance$ required-] 5. ❑ We are a corporation and its 10=❑Electrical cal repairs or additions 3.❑ I am a homaovner doing aU work. .officers have exercised theEr 1 L❑Phnnhing repairs or adefitioms myself[No workers'gip- . right of exemption per MGL 1 ❑I afrepairs aumancerequim- d-]i c.15Z§1{�andweharveno, �� � per) employees.[No woks`. 13_IfdOther J. &roy camp-insurance require&] ;AmyagpM3atB,stcbecUbas K mast also Moatthe secdonbelmsh^s e&C1Lvm&ee campeIISdhhIIpeHcyinE=s9mL ! HamaDwnea teho submit di is.dfidaviE iadicatiug they axe daiag zU wc*sad Bier h¢e outside coahvctarsmast sabmit anew affidavit mdie¢ae sacFi ZMm=ct=ffist d,kl,this box must attarhed as addili®al sheet sbaajng the name of the g and state Zwhethet ar notihose eathiesbwe employees.I€theznh-c=.hzct+sbave employees,theyamsstpmside fheff washers'tamp.PORU number: I am an employer dint isprwidiag warkets'compewadan bmirance for my enrpLayeem dfelvev is fhgpaticy and jab site information. lum mnceCompafry Fame: �1�SG0 l`�cS U�GVlC� Pb Rey 4 or Self-ins-Lic- ` w 1�1,�, f'- T3 D-I Expiration Date: Job Site Address: 'Y-ire CitplStatel1 Gts�i rif#nch a eapp of the workers°coxapensativapoIFcy decTa ratios page(showing the policy member and eipiration Sate). Faihue to secure coverage as required u der Se-etion 25A of MCH_c-1572 can lead to the imposition of criminal penalties of a fide up to$150D OQ asdfar one yearin43 isonment,as w6U as civil penalties in the farm of a STOP WORK ORDER and a fffie of up to$250_0O a clay against the violator.-Be adtdsed ffiat a copy of this statement maybe forwarded to the Office of r la vesfsgations of the DJA for inswmaw coverage vetifica#ion_ I cTe hereby catid r as the s and psrlaffes ofpedwy thatthe informatFazi prmided ahmw is true and correct ,�113ratIIte_ Di ide. Phone iF v QJ%dffl use 071£p: Dv aiat Write M that area,tfr be coinpLeted by city Ort0jrw oJ91crut City or Taws: PerrmciuUcense;g Los .ing Atr6writy(ca de ore): L Board of nvdth _1 Bums g Department 3.Cityt town Clerk d:Electrical hispect or 5.Pimabing Inspector 6.Other Con"act Person: Phone#: -- - - 6 laformation and Tustruefions ; � • " Massach isetts Geherai Laws chaptra 152 req==all employers to provide wormers'compensation for th'--ii MIEPIOY=S- pMMuaottD this stye,an eupIayee is clefined as."'.evecp Person in the seavice of another raider ally contact ofbire, express or implied,oral or writb=f F An Moyer is defined as-ail in via parinersfi�p,assoiai 033y cmporaCion or other legal ently,or aay two or more of the foregoing engaged in a Joint Vie,and including the legal representatives of a.deceased employer,or the receiver or tustee of an iadivic per,association or other Iegal entity,employing employees. However the owner of a.dwelling house baying not more than three aparfineots and who resides therein,or the occupat of the- dwelling house of another who employs persons tD do mafidz ce,consftudion or repay workon such dwelling house or on the grounds or building appurtena�th=to shall notbecanse of such employmentbe deemed to be an employer." MM chaps 152,§25C(t7 also sues 'every state or local liicensIng agency shall wNhhold$ze iota.,ce or- renewal of a license or permit to operate a business or to construct buildings not the comm onWealth for any applirautw•ho has not produced acceptable evidence of compliance with the ing ran ce coverage required." Additionally,MCIL chapter 152,§25CM states-Neither the co=aawealth nor any ofiLs political subdivisions shall enter into any contract for the perfkmance ofpublio wok until acceptable:evidence of compliance vrrth the inset mce.. req=emen s of this chaptrr have been presented to the con ra G�aafhouLy_" AppIicarrLv PIease fill out the work='compensation affidavit completely,by checlong the boxes that apply to your situation and,if necessary,supply sub-contractor(s)nm: e*), address(es)and phone numbers) along with their certificate(s) of insurance. Limitzd LiabMLy Companies(LLC)or LinitedLiabffity-Pa[nemhips(LIP)withno employees other than the members or partners,are not regvaed to carry workers'compensation fi„surance If an LLC or LLP does have employees,a policy is rupire;I Be advised that this affida-vit:maybe submitted to the Department of Tr. ncf,-;al Accidents for confnmation of insurance coverage. Also be sure to sign and date the affidavit The affidavit should be r etnmed to the city or town that the Epp&cation for the petit or license is being rngncsted,not the Department of rnrin mat Accidents-i denim Shaul( you have any gnestions regarding the law or if you.are requfied to obtain a workers' compensation policy,please call the Departmm±at fhe number listed below. Self-ins;a r.QMpanies Should emtnr their self-mince:license number on the appropriah> Iinu. City or Town Officials f Please be sate that the affidavit is complete and pridedlegibly. The Department Las provided a.space at the bottom of the affidavit for you to fli out in the event the Office ofIuvmtigaf?ons has to contact you regarding the applicant: Please be sure to fill in the pun iL l cease number which will be used as a mfb=ce number. In addition,an applicant that must sabnit multiple p=Whcense applications m any gr7ca yew,need only submit one affidavit indicating cm eat policy in. ation(if necessary)and under"Job Site Address"the applicant should v;mt�,"all locations iu (city or town)."A copy of the-affidavit that has been officially stomped or maimed by the city or town may be provided to the . appHcazt as proof that a valid affidavit is on file for fatal pmmdi s or licenses. Anew affidavit must be filled out carh year.Where a homeowner or citizen is obtaining a license or peonitnotrelated to any bitsin'=or commercial v�re (ie. a dog license or pew to bumes Ieav etc.)said pesos.is RIOT=Iaaed to complete this affidavit The Office of Investigafi=would like to thafik you in advance for your cocperaion and should you have any questions, please do not hesitate to give M a call- The De�Z�rtmeufs telephone and fax number. ' CaMMMwI-ath of Mas�nsdb-, , I�gar�aenfi cif 1ad�ia�A�ide�ts �t=of lave timm �4� n Stce� Basin=MA 02111 Tv,-L 4 617 -4900 cxt 4-06 car 1-977-MASSAFE Fax 9 617 727 7M Revised424-07gQg� r TowPn of Barnstable °* Regulatory Services 9RAINSTAEM MASS, $ Richard V.Scali,Director 16c Building Division Tom Perry,Building Commissioner 200 Main Street Hyannis,MA 02601 www.townbarnstable.ma.us Office: 508-862-4038. Fax: 508-790-6230 �Y Prop e Owner Must Complete and Sign This Section ' If Using ABuilder . I, VL as Owner of the subject property herebyauthorize e e �OtI� Gtl�.��'d' ��L�J �2 to act on my behalf, 4 , y in all matters relative to work authorized bythis bolding permit application.for: (Address of job). Pool fences and alarms are the responsibility of the applicant. Pools ' are not to be filled or utilized before fence is installed and all final inspections are performed and accepted. Skndture of Own r of Applicant Prin Name _ �, Print N Date Q:FORMS:OWI,UWERMISSIONPOOIS Town of Barnstable Regulatory Services THE ro Richard V.Scali,Director Building Division i RARNSX-433 .F. Tom Perry,Building Commissioner XAS& 200 Main Street, Hyannis,MA 02601 www.town barnstable.ma_us Office: 508-862-4.038 Fax: 508-790-6230 HOMEOWNER LICENSE EXEMMON Please Print DATE: JOB LOCATIOK number street village "HOMEOWNER: name home phone# work phone# CURRENT MAILING ADDRESS: ----- - ---- city/town state lip code ' The current exemption for"homeowners"was extended to include owner-occupied dwellings of six units or less and to allow homeowners to engage an individual for hire who does not possess a license,provided that the owner acts as supervisor_ DEFINITION OR HOMEOWNER Person(s)who owns a parcel of land on which he/she resides or intends to reside,on which there is,.or is intended to be,a one or two- family dwelling, attached or detached structures accessory to such use and/or farm structures. A person who constructs more than one home in a two-year period shall not be considered a homeowner. Such"homeowner"shall submit to the Building Official on a form acceptable to the Building Official,that he/she shall be responsible for all such work performed under the building permit. (Section 109.1.1) The undersigned`homeowner"assumes responsibility for compliance with the State Building Code and other applicable codes, bylaws,roles and regulations. The undersigned"homeowner"certifies that he/she understands the Town of Bamstable Buildmg Department minimum inspection procedures and requirements and that he/she will comply with said procedures and requirements. Signature of Homeowner Approval of Building Official •_Note: Three-family dwellings containing 35,000 cubic feet or larger will be required to comply with the State Building Code Section 127.0 Construction Control. HOMEOWNER'S EXEMPTION The Code states that: "Any homeowner performing work for which a building permit is required shall be exempt from the provisions of this section(Section 109.11-Licensing of contraction Supervisors);provided that if the homeowner engages a person(s)for hire to do such work,that such Homeowner shall act as supervisor." Many homeowners who use this exemption are unaware that they are assuming the responsibilities of a supervisor. (see Appendix Q,Rules&Regulations for Licensing Construction Supervisors,Section 2.15) This Iack of awareness often results in serious problems,particularly when the homeowner hires unlicensed persons. In this case,our Board cannot proceed against the unlicensed person as it would with a licensed Supervisor. The homeowner acting as Supervisor is ultimately responsible. To ensure that the homeowner is fully aware of his/her responsibilities,many communities require,as part of the permit application,that the homeowner certify that he/she understands the responsibilities of a Supervisor. On?the Iast page' of this issue is a form currently used by several towns. You may care t amend and adopt such a form/certification for nse in your community. Q:IWPFILESWORMS\buildmg permit fo=\EXPRESS.doc Revised 061313 YARDLAN-01 DPEARSE ACORD' DATE(MMIDDIYYYY) CERTIFICATE OF LIABILITY INSURANCE 3/23/2016 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S),AUTHORIZED` REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT Rogers&Gray Insurance Agency,Inc. NAME: _ PHONE FAX 434 Rte 134 A/c No Ext: Alc,No):(877)816-2156 South Dennis,MA 02660 AIL ADDRESS:mail@rogersgray.com INSURER(S)AFFORDING COVERAGE NAIC# INSURER A:Arbella Protection INSURED INSURER B:Wesco Insurance Company Yardscape Landscape&Irrigation Inc& INSURER C: , Bella Pools 327 Whites Path Road INSURER D: South Yarmouth,MA 02664 INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT.THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN&SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR TYPE OF INSURANCE DD SUBR POLICY EFF POLICY EXP LIMITS LTR INSD WVD POLICY NUMBER MMIDDIYYYY MMIDDIYYYY A X COMMERCIAL GENERAL LIABILITY - EACH OCCURRENCE $ 1,000,000 CLAIMS-MADE T�bCCUR 8500046547 03/18/2016 03/18/2017 DAMAGE TO RENTED 100 OOO PREMISES Ea occurrence $ MED EXP(Any one person) $ 5,000 PERSONAL&ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ - 2,000,000 POLICY1-1 JECT LOC - PRODUCTS-COMP/OP AGG $ 2,000,000 OTHER: $ AUTOMOBILE LIABILITY - - COMBINED SINGLE LIMIT Ea accident $ 1,000,000 A ANY AUTO + 1020015747 0311812016 03/18/2017 BODILY INJURY(Per person) $ ALL OWNED X AUTOS SCHEDULED+ AUTOS _ BODILY INJURY(Per accident) $ X X NON-OWNED _ - - PROPERTY DAMAGE $ HIRED AUTOS AUTOS Per accident L, $ X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 1,000,000 A EXCESS LIAB CLAIMS-MADE 4600046549 - 03/18/2016 03/18/2017 AGGREGATE $ DED I X I RETENTION$ 10,000 ... $ WORKERS COMPENSATION - PER OTH- AND EMPLOYERS'LIABILITY STATUTE ER B ANY PROPRIETOR/PARTNER/EXECUTIVE Ya N 1 A WWC3143369 _ 06/07/2015 06/07/2016 E.L.EACH ACCIDENT - $ 1,000,000 OFFICER/MEMBER EXCLUDED? (Mandatory in NH) - E.L.DISEASE-EA EMPLOYEE $ 1,000,000 If yes,describe under - -DESCRIPTION OF OPERATIONS below - - E.L.DISEASE-POLICY LIMIT $ - 1,000,000 :EE _T DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,maybe attached if more space is required) .. .. Landscape&Gardening Contractor Workers Comp Information-Officers Included Project:Ray Garrahan,3 Larch Lane,Centerville CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Town of Barnstable THE EXPIRATION DATE THEREOF, NOTICE WILL. BE DELIVERED IN 367 Main Street ACCORDANCE WITH THE POLICY PROVISIONS. Hyannis,MA 02601 AUTHORIZED REPRESENTATIVE @ 1988-2014 ACORD CORPORATION.All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD Office of Consumer Affairs and Bulsiness Regulation 10 Park Plaza - Suite 5170 Boston, Massachusetts 02116 Home Improvement Contractor Registration Registration: 149188 Type: Private Corporation Expiration: 12/2/2017 Tr# 272848 YARDSCAPE LANDSCAPE & IRRIGATION, JEFFREY FANARA 327 WHITE'S PATH ---_._------.____---_-------_.-----___.__---------__--------.......----_. . I S YARMOUTH, MA 02664 Update Address and return card.Mark reason for change. Address Renewal Employment Lost Card SCA 1 ES 20M-05/11I --_� �_ .I I Office of consumer Affairs&Business Regulation License or registration valid for individul use only � f4OME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: tegistration: 149188 Type: Office of Consumer Affairs and Business Regulation r 10 Park Plaza-Suite 5170 Expiration: 12/2/2017 Private Corporation Boston,MA 02116 I YARDSCAPE LANDSCAPE& IRRIGATION,INC. JEFFREY FANARA 327 WHITE'S PATH S YARMOUTH, MA 02664 Undersecretary Not valid without signature I Office of Consumer Affairs and Business Regulation' 10 Park Plaza - Suite 5170 Boston, Massachusetts 02116 Home Improvement Contractor Registration Registration: 149188 i Type: Private Corporation f Expiration: 12/2/2017 Tr►/ 272848 YARDSCAPE LANDSCAPE & IRRIGATION, JEFFREY FANARA 327 WHITE'S PATH - -- _ S YARMOUTH, MA 02664 Update Address and return card. Mark reason for change. Address Renewal Employment L" Lost Card SCA 1 C. 20M-05/11 =. OI't"icc of Consumer Affairs&Business Regulation License or registration valid for individul use only l� IiOME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: i registration: 149188 Type: Office of Consumer Affairs and Business Regulation t 10 Park Plaza-Suite 5170 x xpiration: 12/2/2017 Private Corporati<,;� Boston,MA 02116 YARDSCAPE LANDSCAPE& IRRIGATION, INC. JEFFREY FANARA 327 WHITE'S PATH S YARMOUTH, MA 02664 Undersecretary Not valid without signature Map Pagel of 2 Town of Barnstable Geographic Information System 46 New Search Home Help Parcel Custom Ma Abutters Map SizeIm IN Zoom Out In viewer l91� a— '=JPG ' 189086, 189083.: 0101 - "85 189062 ' 189D06002 - i75i 189081 p 39 16900801 " 0:1934 5 N 24 189008004: 1 93 Map: 189 Parcel: 006-004 Full 189008005 Property' Location: 3 LARCH LANE Info Owner: GARRAHAN,RAYMOND JR 189008008 189087� "23 "19276 ($:Yd Location Information dyl I Map&Parcel 189006004 109008007 - Location 3 LARCH LANE N31 Acreage 0.52 acres 89 Fee#. - "1B4B Current Owner Mailing Address GAR RAHAN,RAYMOND JR 3 LARCH LANE CENTERVILLE,MA 02632 Set Scale 1°= 89 I Aerial Photos MAP DISCLAIMER . . tt Copyright 2005.2010 Town of Barnstable,MA All rights reserved.Send quls 0�i�ARAMeALk to GIS$33,700 .BarnstableMA v1.2.5833(Production; Out Buildings $2,400 Land $113,000 Buildings $126,500 Total Appraised $275,600 Assessed value(FY 2016) Extra Features $33,700 Out Buildings $2,400 Land $113,000 Buildings $126,500 Total Assessed $275,600 Construction Detail Style Cape Cod Model Residential Grade .Average Stories 1 1/2 Stories Exterior Wall Wood Shingle Roof Structure Gable/Hip Roof Cover Asph/F GIs/Cmp Interior Wall Drywall Interior Floor Carpet Heat Fuel Gas Heat Type Hot Air - - AC Type Central Number of 3 Bedrooms Bedrooms Number of 2 Full-0 Half Bathrooms Total Rooms 6 Rooms - Living Area 1330 Replacement Cost. $152,418 Year Built 1986 Depreciation 17 Building Sketches http://66.203.95.236/arcims/appgeoapp/map.aspx?propertyID=l 89006004 3/21/2016 oF,IKE Town of Barnstable *Permit - �' Expires 6 months from issue date Regulatory Services Fee * MRNSPASLE, : Thomas F. Geiler;Director MASS. Building Division ���c �j JO Tom Perry,CBO, Building Commissioner v ' '200 Main Street,Hyannis,MA 02601 www,town.batiistable.ma.us Office: 508-862-4038 Fax: 508-790-6230 EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY f , Not Valid without Red X-Press Imprint Map/parcel Number Property Address LAiLeZ\ Residential Value of Work nSdO Minimum fee of$25.00 for work under $6000.00 Owner's Name&Address `�`� 1.' OA Ck C-Az-a4s,"AA Contractor's Name Telephone Number Home Improvement Contractor License#(if applicable) ❑Workman's Compensation Insurance -PS PERMIT Check one: ❑ I am a sole proprietor NOV 14 2008 Q11I am the Homeowner ❑ I have Worker's Compensation Insurance TOWN OF BARNSTABLE Insurance Company Name Workman's Comp. Policy# Copy of Insurance Compliance Certificate riiust be on file. Permit Request(check box) v j [9""Re-roof(stripping old shingles) All construction debris will be taken to ❑ Re-roof(not stripping. Going over existing layers of roof) ❑ Re-side ❑ Replacement Windows/doors/sliders. U-Value (maximum.44), r`y; *Where required: Issuance of this permit does not exempt compliance with other town department regulations, e:His?orc,Corser a4oi;,eta .?i ***Note: Property Owner must sign Property Owner Letter of Permission, o A copy of the Home Improvement Contractors License is required. Nj Gs SIGNATURE: Q:\WPFILES\FORMS\building permit forms\EXPRESS.doc Revise020108 The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations ' 600 Washington Street Boston,MA 02111 www.mass.gov/dia Workers' Compensation I ura_nce idavit: Builders/ ontractors/Electricians/Plumbers Applicant Information Please Print Le ibl Name(Business/Organization/Individual): Address: 3 1_14 Q L-taN City/State/Zip: 0_6 t. c c 1�e, VMS-. Oa 3)-Phone.#: _7 T I —'At 0 `7 7&G, Are you an employer?Check the appropriate box: Type of project(required): 1.❑ I am a employer with 4. I am a general contractor and I 6. ❑New construction employees(full and/or part.-time).* have hired the sub-contractors .2:0 I am a sole proprietor or partner-' listed on the attached sheet. 7. .0 Remodeling ship and have no employees These sub-contractors have g. Demolition working for me in any capacity. employees and have workers' 9. Building addition [No workers' comp.insurance comp. insurance.$ uired.] 5. 0 We are a corporation and its 10.❑ Electrical repairs or additions 3.YI am a homeowner doing all work officers have exercised their 11.❑Plumbing repairs or additions myself.[No workers' comp. right of exemption per MGL 12.❑Roof repairs insurance required.]t c. M, §1(4),and we have no employees. [No workers' 13.❑ Other comp.insurance required.] 'Any applicant,that checks box#1 must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. TContractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: Policy#or Self-ins.Lic.M Expiration Date: Job Site Address: City/State/Zip: Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage.as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine tip to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification: I do hereby ce fy under the pa' and penalties of perjury that the information provided above is true and correct Signafore: Date: 1 t 1`J 0 it Phone#: —Ott D -- r n 6 w Official use only. Do not write in this area,to be completed by city or town official City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: Information and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for their employees. Pursuant to this statute,an employee is defined as "...every person in.the service of another under any contract of hire, express or implied,oral or written." An employer is defined as"an individual,partnership,association,corporation or other legal entity,or any two or more --of the foregoing-enga�-m a-jomt enteipise=and uielu3uig-=tlie legal7tepr-esen-ta'tveg of-�--deceased--employer,-or_-the_::—_._. ::-__ receiver or trustee of an individual,partnership,association or other legal entity,employing employees. However the owner of a dwelling house having not.more than three apartments and who resides therein,or the occupant of the dwelling house of another who employs persons to do maintenance,construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152, §25C(6)also states that"every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced-acceptable evidence of compliance with the insurance coverage required." Additionally,MGL chapter 152, §25C(7)states`Neither the commonwealth nor any of its political subdivisions shall . enter into any contract for.the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority." Applicants Please fill out the workers'compensation affidavit completely,by checking the boxes that apply to your situation and, if necessary,supply sub-contractors)name(s),address(es)and phone number(s)along with their certificate(s)of insurance. Limited Liability Companies'(LLC)or Limited Liability Partnerships(LLP)with no employees other than the members or partners,are not required to carry workers' compensation insurance. If an LLC or LLP does have employees,a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested,not the Department of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' compensation policy,please call the Department at the number listed below. Self-insured companies should enter their self-insurance license number on the appropriate line. City or Town Officials Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the permit/license number which will be used as a reference number. In addition,an applicant that must submit multiple permit/license applications in any given year,need only submit one affidavit indicating current policy information(if necessary)and under"Job Site Address"the applicant should write"all locations in (city or town).".A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year.Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e.a dog license or permit to bum leaves etc.)said person is NOT required to complete this affidavit, The Office of Investigations would like to.thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call. The Department's address,telephone-and fax number: The Commonwealth of Massachusetts Department of Industrial Accidents Mee of Investigations 600 Washington Street Boston, MA 02111 Tel. #617-727-4900 ext-406 ar 1-877-MASSAFE - Fax#617-727-7749 Revised 11-22-06 www.mass.gov/dia i oft"Era,� Town of Barnstable Regulatory Services f pp i B"NSMBM HAM �, Thomas F.Geiler,Director n 19. ' Building Division Tom Perry,Building Commissioner 200 Main Street,Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 Property Owner Must r, Complete and Sign This Section , , - If Using A Builder t I> , as Owner of the subject property hereby authorize to act on my behalf, in all matters relative to work authorized by this building permit application for: , (Address of Job) Signature of Owner Date Print.Na.me If Property Owner is applying for permit please complete the Homeowners License Exemption Form on the reverse side. s Q:FORMSDIA NERPERMISSION i r - .r Town of Barnstable y�P�oF THE Regulatory Services t Thomas F.Geiler, aatinrsrwsre. ,Director rftwsa Building Division "lED►M'I a Tom Perry,Building Commissioner www.town.barnstable-ma.us Office: 508-862-4038 Fax: 508-790-6230 HOMEOWNER LICENSE EXEMPTION Please Print DATE: JOB LOCATION: 37 - number � �, ,, - _ ._sulstree� village "HOMEOWNER": V`" .4 IAJ`e3+��� C�T�'�"` —7 FI col 1 ®— 7 7C� name ,� -q home phone# work phone# CURRENT MAILING ADDRESS: `I Y LJ ta,2ck_ �4— LA)NJaAeo VAW- B i IFaO city/town state zip code The current exemption for"homeowners"was extended to include owner-occupied dwellings of six units or less and to allow homeowners to engage an individual for hire who does not possess a license,provided that the owner acts as supervisor. DEFINITION OF HOMEOWNER Person(s)who owns a parcel of land on which he/she resides or intends to reside,on which there is, or is intended to be, a one or two-family dwelling,attached or detached structures accessory to such use and/or farm structures. A person who constructs more than one home in a two-year period shall not be considered a homeowner. Such "homeowner"shall submit to the Building Official on a form acceptable to the Building Official,that he/she shall be responsible for all such work performed under the building permit. (Section 109.1.1) The undersigned"homeowner"assumes responsibility for compliance with the State Building Code and other applicable codes,bylaws,rules and regulations. The undersigned."homeowner."certifies that.he/she understands.the.Town of Barnstable Building Department minimum inspection pro dares and requirements and that he/she will comply with said procedures and re ements. �J� Signaturg Homeowner Approval of Building Official Note: Three-family dwellings containing 35,000 cubic feet or larger will be required to comply with the State Building Code Section 127.0 Construction Control. HOMEOWNER'S EXEMPTION The Code states that: "Any homeowner performing work for which a building permit is required shall be exempt from the provisions of this section(Section 109.1.1 -Licensing of construction Supervisors);provided that if the homeowner engages a persons)for hire to do such work,that such Homeowner shall act as supervisor." Many homeowners who use this exemption are unaware that they are assuming the responsibilities of a supervisor(see Appendix Q, Rules&Regulations for Licensing Construction Supervisors,Section 2.15) This lack of awareness often results in serious problems,particularly when the homeowner hires unlicensed persons. In this case,our Board cannot proceed against the unlicensed person as it would with a licensed Supervisor. The homeowner acting as Supervisor is ultimately responsible. To ensure that the homeowner is fully aware of his/her responsibilities,many communities require,as part of the permit application, that the homeowner certify that he/she understands the responsibilities of a Supervisor. On the last page of this issue is a form currently used by several towns. You may care t amend and adopt such a fomfcertification.for use in your community. e ' Q:forms:homeexempt .1 13164 �p�'041 �a�ti Town of Barnstable *Permit# r77854 Expires 6 months from issue date • STABM + Regulatory Services FeeMAM d � s639. ,�$ Thomas F.Geiler,Director�FD A Building Division Tom Perry, Building Commissioner 200 Main Street, Hyannis,MA 02601 Office: 508-8624038 Fax: 508-790-6230 EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY p Not Valid without Red X-Press Imprint Map/parcel Number Property Address ,3 , A f" oqt9 r- Jglesidential Value of Work j .60 Minimum fee of$25.00 for work under$6000.00 Owner's Name&Address A4& Contractor's Name 77>�i_R �6til tt►��Cp Telephone Number !'®k-7'7,r-4W,6/ Home Improvement Contractor License#(if applicable) Construction Supervisor's License#(if applicable) ❑Workman's Compensation Insurance Check one: X-PRESS PERMIT ❑��am a sole proprietor PERMIT ! 1 am the Homeowner ❑ I have Worker's Compensation Insurance J U L 7 ' 2004 rA Insurance Company Name TOWN OF BARNSTABLE Workman's Comp.Policy# Copy of Insurance Compliance Certificate must be on file. Permit Request(check box) ❑ Re-roof(stripping old shingles) All construction debris will be taken to ❑Re-roof(not stripping. Going over existing layers of roof) ❑ Re-side ❑ Replacement WTdo'ws. U-Value (maximum.44) *Where required: Issuance of this permit does not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc. ***Note: Property Owner must sign Property Owner Letter of Permission. H quired. Signature Q:Forms:expmtrg Revise063004 TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION 4(K y Map Parcel eo(a ® " . t, Permit# 3 .91 q--+ •d Date Issued -7- GmsaA tf9n- ision / Fee C-9 ®� / Tax Collector Treasurer `p %• • , P1a -kept. Plan Approved by Planning Board HisMTt-=0'KH P-resew' I;/ annis Project Street Address • zl�z 1417V19- .Village Owner �?! A, oz, Address ' 44,yxic— Telephone --Permit Request !- `Ta_►-c) �i ��.,�5' /®7`' Square feet: 1 st floor: existing proposed 2nd floor:existing 7,016' proposed - - Total new 7�6 Estimated Project Cost 4 fa 0 0 Zoning District Flood Plain Groundwater Overlay Construction Type Gc�o6 e Lot Size , `y Grandfathered: ❑Yes ❑.No If yes, attach supporting documentation. Dwelling Type: Single Family ,Two Family.❑ Multi-Family(#units) +' Age of Existing Structure / !�S• Historic House: ❑Yes ' G40 On Old King's Highway: ❑YesC04o Basement Type: a Full '❑Crawl ❑Walkout' ❑Other Basement Finished Area s ft i `' Basement Unfinished Area s ft 7 ,//, _Number of Baths: •Full:,existing new 'AldwF_ Half:existing =(2 — ,new I Number-of Bedrooms: existing�_ new c� + Total Room Count(not including baths):existing new - First Floor Room Count Heat Type and Fuel: a`Gas ❑Oil ❑,Electric ❑Other Central Air: O'Yes ❑No Fireplaces: Existing f New -0 Existing wood/coal stove: lies ❑No I Detached ara e:❑existin ❑new size Pool:O existin ❑new size Barn:❑existin ❑new size 9 g g 9 g Attached garage:Wr/existing ❑new size Shed:❑existing O new size Other: I` Zoning Board of Appeals Authorization ❑ Appeal,# Recorded❑ Commercial ❑Yes ❑No If yes,site plantreview# Current Use Proposed Use - BUILDER INFORMATION Name Telephone Number Address ���r L,. vim License#" Home Improvement Contractor# Worker's Compensation# ALL CONSTRUCTION DEB RESULTING FRO THIS PROJECT WILL BE TAKEN TO a SIGNATURE DATE f. • FOR OFFICIAL USE ONLY PERMIT NO. IF DATE ISSUED .' 1 MAP/PARCEL_ NO, 4.4 ADDRESS VILLAGE y ' OWNER • ;y�y�y1 , - ' �' }f-... .`.� _= _ s .— .. .*` T,.. —.. 1, DATE OF,INSPECTIONi FOUNDATION FRAME INSULATION FIREPLACE i r � _ I r �4 r .. a_ . _ y t is t •_ t-- rr ELECTRICAL: ROUGH FINAL c p y y PLUMBING: ROUGH I FINAL GAS: ROUGH FINAL ti FINAL BUILDING I el DATE CLOSEDiOUT. ASSOCIATION,PLAN NO. The Town of Barnstable a 16 Department of Health Safety and Environmental Services Building Division 367 Main Street,Hyannis MA 02601 Office: 508-862-4038 Ralph Crossen Fax: 508-790-6230 ,-'Building Commissioner Permit no. Date AFFIDAVIT r HOME IMPROVEMENT CONTRACTOR LAW SUPPLEMENT TO PERMIT APPLICATION MGL c. 142A requires that the"reconstruction,alterations,renovation,repair,modernization,conversion, improvement,removal,demolition,or construction of an addition to any pre-existing owner-occupied building containing at least one but not more than four dwelling units or to structures which are adjacent to such residence or building be done by registered contractors,with certain exceptions,along with other requirements. " Re� l�ce sl -ee a Type of Work: ld s Estimated Cost Z � �� o Address of Work: -3 L CC V C W L-a pt� e e Pt le r y t f— Owner's Name: iZ/-I- Ll ym-a W 0 f/-4- ✓✓•cL h i4/L) Date of Application: Z Z I hereby certify that: Registration is not required for the following reason(s): Work excluded by law E3Job Under S1,000 �B 'lding not owner-occupied wner pulling own permit Notice is hereby given that: OWNERS PULLING THEIR OWN PERMIT OR DEALING WITH UNREGISTERED CONTRACTORS FOR APPLICABLE HOME IMPROVEMENT WORK DO NOT HAVE ACCESS TO THE ARBITRATION PROGRAM OR GUARANTY FUND UNDER MGL c. 142A. SIGNED UNDER PENALTIES OF PERJURY I hereby apply for a permit as the agent of the owner. Date Contractor Name Registration No. O / Date Owner's Name q:forms:Affidav A llVr 1 V ♦• li Vi iPiWi aa►6.0vis060avi Department of Health Safety and Environmental Services Building Division HAM 367 Main Street,Hyannis MA 02601 �a Office: 508-862-4038 Ralph Crossen Fax: 508-790-6230 Building Commission; SOMEOVINMLUMMEXEMMON Pltsere Print DATE. 'I /z3 / 5 JOB LOCATION: manber sneer , / pillage .�. "WN SOWN W: t .'l9 e ' V/2 D - F 7 X 5V ttama home pbona# wak phone# CURRE4T MAUMG ADDRESS: ZKye , dtydtawm :taa tip code The current exemption for was extended to include of sic units or less and to allow homeowners to engage anmdividuai for hire who does not posses a license,nrtovided that the owner a�pt830S>?L DF.FIIV[IION oBSOMEOnVNER Person(s)who owns a parcel of land an which he/she resides or imends to reside,an which there is,or is intended to be,a one or two-family dwelfing,attached or detached strnmues accessory to sack use and/or farm swwtsnes. A person who constructs more than an home m a two-year period shall not be considered a homeowner. Such _ ."homeowner"small submit to the Boil ft Off cial on a fa m accePuble to the BaOdiag Offiaai,that h lth -shall be =sffle fer ail such wm*Mffg med Linder the buffi ins=Mit_ (Section 109.1.1) The undersigned"homeowner"awes re�ponsibRitY for comPlisna with the State Heralding Code and other applicable codes,bylaws,rules and regulations. The undersigned"homeorovner'certifies that he/she undesstmids the Town of Barnstable Budding Department minimum' procedures requirements and that he/she will comply with said procedures and sigtia=of Approval ofBu kftMiai Note: Three-family dwellings c c=filiag 35,000 cubic feet ar lmW wffl be required to comply with the State Building Code Section 1Z7.0 Consuaction Comrol. HOMEOWNEWS EWIiTON Mo Carla sterna that 'Any bomteowner pabaemmg wodc forwbich a budding pamtt is Aail be estmrpt fmm the pmt+tsiatrs of tins notion(Seldom 109.1.1-Li OW*of oomsuuctiam Supavism);pub that if the hnum rcr etrgaga a pe mu(s)for hire to do such walk that arch Hommwoa snail art as sgmwhw:' M=y hommwners who tun ffita aotmp-1 am umawara t mfty ado mom i n the rapoms&Ui8a of a supmviw(see Appardac Q. Ruin&Reguiadoms far Lioe=g Comuctl m Sgwvisots,Sa dun 2.15) 116 fade cf awattate::ORea results im saioas problems, partienlady whin the bamww=bhas nnlioaraad persons. tin this=W ota Board cwmot ptooeed agaimaffie uoitce ad permn as it would with aHu med Supervisor. Mw houtwww acting as Supervisor isuMmUdY t P=ibie. To ewn that tha homeowner is hily aware of Mafia rapomibilidm mmy M pact of the perms applicav= that the *that hd tte the M ofa Supeno Oa tha iast pie of this issue is a form ameatly cud by sevaai towns. 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M • • 1 w•�:1 •Ili_ 11 •1. 1 ✓.111 1 1 II to III 11 II • w•1111 Vwl V 11111fill-- • II MI I / I Y�I .11w w1 Y 111111 I .. 1 11 • ' (/� 11✓• ' 1 ..111.1 �• Is 1 • •11 �•11 • ' 11 V.1 •1 111 • 11 .1 1 .11 • �r1 �•11•: 1 / awl 11✓. 1 1 i1 • 1 _ • •KI• •11 • 1 Ire • 11 k.11 , • 1 I iip.11 •I e 1 v•• • �/ .0 ell .11 I 1 • 1 • 1 1 / 1 �. • •11 jMjj ����...... 1 1 • 111 ,•,el . I 11 w.V: 1 • 1 •11 •11 l /:►' 11 111 •:.1 1 1 . 111 1 I I ro rrrT 1-0 T, 1 1 I I 1� .�Assessors ma and lot number SEPTIC SYSTEM MUST EE ,,o o�♦ ........ ..®.g.3............... .... INSTALLED IN COMPLIANCE Se�d6ge Permit number WITH TITLE 5 Z BARNSTADLE, House number ..... .. .! �'...........:. ' rasa ............•••• ENVIRONMENTAL CODE AND o, mum TOWN REGULATIONS' oMara� TOWN OF BARNSTABLE BUILDING IHSPECTQ ..�: APPLICATION FOR PERMIT TO ................ ......... �. . Q..................................-:---:-------:-- TYPE OF CONSTRUCTION ............::...........Vo-ato........� i A ....�0:�`.....[.6................>I 9 . f TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information- T.Location ............. "'. ..... ............ ..... . CX!?^�.........C .....!.....:.��............................... ProposedUse ............0:....... .. .... !1 ................................................................................................................................ Zoning District ...................QQ-, ...............................................Fire District ..............C� ®......,.............................................. Name of Owner �J�S L. �J�` ...................Address . e.........�........13 DST l Cl�G ... ..t..... .. . ....�..Y l C 1 ( cc c• �� Name of Builder ..f L`' cL.. ...C�.. ��.....� r....Address ............................. Name of Architect .. . ....... .......Address .......yGtN✓!rr,`�?('ti Pq-.!'f-........ ... i Number of Rooms ...................: ...........................................Foundation .......... .f ........ Exterior �:�?`� ..:Roofing ......................�.��........:.:.................................. .......r V. :............................... Floors .....................: ........ ..:. .. Interior .................. . Heating ...................... ..................................::................Plumbing ............... Fireplace ................... ............................. .............Approximate. Cost ��®d7I........................................................ Definitive Plan Approved by Planning Board ___ ______ ___l_______19 5 Area ....... .y�.................... Diagram of Lot and Building with Dimensions Fee 7..�75............. SUBJE T TO APPROVAL OF BOARD OF HEALTH /736, 36 d• 1 Y� OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. Name . ..... . . f01!/J.............. Construction Supervisor's License ��� ' _ far S L S . TRUST No AZ9053,. Permit for 11 Stor SnSle„Familx.,Dwelling....................... i Location ....h� ... .4. .....3..�ar�k�..Lane.............. t _ .. : ................... .................................... I Owner ....S..L 5.:..Trust..........I.......................... Type of Construction ....EXAMP............................ • r _ i ti ............................................... .............................. Plot ............................ Lot ................................ f f March 19, 86 Permit Granted o. ........................................19 "Date of Inspection . Date Completed C '"'f i.. '. f r t iw rt f' P o q'l Assessor's map and lot F TH E number— .................... C t0 Sewage Permit number ........ .... . Z IA"STLB", i House number . ........ G...........................:...... 90 MAM Oq�039. 9� 'F0 MAY a� /TOWN OF BARNSTABLE BUILeDING INSPECTOR APPLICATION FOR PERMIT TO ................ ........... .............. TYPE OF CONSTRUCTION ......................... ........ ......**-1- .....*—**...:.:::.......................... ......... ... ......!A. ...1.............19 1-.1L TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: Location.............k�r..... ........ .: \..... . r�v v v i?.......:.. 2^'l f ,�, ..................................................... ProposedUse ............. ................................................................................................................................ Zoning District ...................V��.............................................Fire District ..............C. ©..................................................... 1': .... � L ...................................Address ....... ........................................ ..� . ? �-......Name of Owner .. cs ct. ��. r� DPJtr4! Name of Builder .......... .. .......!7.:f:Q.�J.L....�........................Address ......................................:............................................. Name of Architect ... V.Cnr; ....... P�..11'11A......... Address .... ?-....�: ......./a: ((�IeCt� ............. Numberof Rooms ...................Foundation ................................ ....:..................... .. ................... .............. Exterior ........................................Roofing r :............................................ ........... Floors .....................Q,L U.!(tTT:n..... .....Interior .................... i`i �. ✓l pC ........ .................... a Heating ................ ......... ;.......................Plumbing ........ ..... r/C ��C� 17/�P�c......:..�.. ,, G ��1 1 Fireplace ......................d. !. ..............................: ..............Approximate. Cost .......... �L ......... Definitive Plan Approved by Planning Board __ -- Area Diagram of Lot and Building with Dimensions Fee ............................................. SUBJECT TO APPROVAL OF BOARD OF HEALTH =- ' 4 t 4 Zf OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. Name 1 - ..... :��" ..... �j aConstruction Supervisor's License .... ........................ S L S TRUST A=189-000(, . 00 No 29053 permit for ....1j Story ............................... Single Family Dwelling ......................................... Location Lot #.4 3 Larch Lane Centerville Owner .......S..L„S Trust Type of Construction .....FKame ................... ................................................................................ Plot ............................ Lot . Permit Granted „March:. 19, 19 86 t Date of Inspection ....................................19 Date Completed .................. . .................19 10Mpl-,6�1E 11187 ° TOWN OF BARNSTABLE BUILDING DEPARTMENT _ DA"°TAU ! TOWN OFFICE BUILDING .631. �� HYANNIS, MASS. 02601 �o iur r. MEMO TO: Town Clerk FROM: Building Department DATE: An Occupancy Permit has been issued for the building authorized by Building Permit #...... ...02 p .....<..®�. 3...................................................................................................... ._...... ............... issued to _.. �..1 .... ! ........7........... J�GrG ...... `�.e........ . .< �e .✓�v Please release the performance bond. ,FTHE? TOWN OF BARNSTABLE Permit -No. ...?9053..... BUILDING DEPARTMENT { ...... °8;' I TOWN OFFICE BUILDING Cash �uriv HYANNIS,MASS.02601 Bond x n CERTIFICATE OF USE AND OCCUPANCY Issued to S L S Trust i Address Lot #4, 3 Larch Lane Centerville, Massachusetts USE GROUP FIRE GRADING OCCUPANCY LOAD THIS PERMIT WILL NOT BE VALID, AND THE BUILDING SHALL NOT BE OCCUPIED UNTIL SIGNED BY THE BUILDING. INSPECTOR.UPON SATISFACTORY COMPLIANCE WITH TOWN REQUIREMENTS AND IN ACCORDANCE WITH SECTION 119.0 OF THE MASSACHUSETTS STATE BUILDING CODE. .......,......E� ..... 19..............:.. ......... Building Inspector i BUILDING "TOW?i OF BARNSTABLE, MASSACHUSETTSPERMIT ItQI. I}-6 JOB WEATHER CARD DATE 19 ,i PERMIT NO. a�4. 29053 Lc:beJ. Sollo1N5 ), vel. 13 Gin i.u.:. ?_,tea Zt,j 3.T1 I1 °. ^'• ,( .i APPLICANT ADDRESS , 6 NO.) (STREET) (CONTR'S LICENSE) Build NUMBER OF PERMIT TO (_r STORY Vt `"'"F' DWELLING UNITS (TYPE OF IMPROVEMENT) NO. (PROPOSED USE) a v �.._.. . a. LUC iO4 S l,d?rC�l i, ,.:.lu 1_¢:;;L.;C'y: ZONING AT (LOCATION) DISTRICT (NO.) (STREET) BETWEEN AND (CROSS STREET) (CROSS STREET) LOT SUBDIVISION LOT BLOCK, SIZE BUILDING IS TO BE FT. WIDE BY FT. LONG BY FT. IN HEIGHT AND SHALL CONFORM IN CONSTRUCTION TO TYPE USE GROUP BASEMENT WALLS OR FOUNDATION (TYPE) REMARKS: r . AREA OR 1244 zq. 1l. PERMIT 14. 15 VOLUME ESTIMATED COST .� FEE .� (CUBIC/SQUARE FEET) ' OWNER BUILDING DEPT. el, ADDRESS BY THIS PERMIT CONVEYS NO RIGHT TO OCCUPY ANY STREET, R: ALLEY OR. SIDEWALK OR ANY PART THEREOF. EITHER OR PERMANENTLY: ENCROACHMENTS ON PUBLIC PROPERTY, NOT SPECIFICALLY PERMITTED UNDER THE BUILDING CODE, MUST BE.AP- PROVED BY THE JURISDICTION. STREET OR ALLEY GRADES AS WELL AS DEPTH AND LOCATION OF PUBLIC SEWERS MAY BE OBTAINED i FROM THE DEPARTMENT OF PUBLIC WORKS. THE ISSUANCE OF THIS PERMIT DOES NOT RELEASE THE4'APPLICANT FROM THE CONDITIONS OF ANY APPLICABLE SUBDIVISION RESTRICTIONS. 'MINIMUM OF THREE CALL APPROVED PLANS MUST RETAINED ON JOB AND THIS WHERE APPLICABLE SEPARATE INSPECTIONS REQUIRED FOR PERMITS ARE REQUIRED FOR - ALL CONSTRUCTION WORK: CARD KEPT POSTED UNTIL FINAL INSPECTION HAS BEEN ELECTRICAL, PLUMBING AND I. FOUNDATIONS OR FOOTINGS. MADE. WHERE A CERTIFICATE OF OCCUPANCY IS RE- MECHANICAL INSTALLATIONS. 2. PRIOR TO COVERING STRUCTURAL gUIRED,SUCH BUILDING SHALL NOT BE OCCUPIED UNTIL MEMBFINAL INSPECTION TI TO BEFORE FINAL INSPECTION HAS BEEN MADE. 3. FINAL INSPECTION BEFORE OCCUPANCY. POST THIS CARD SO IT IS VISIBLE FROM STREET BUILDING INSPECTION APPROVALS PLUMBING INSPECTION APPROVALS ELECTRICAL INSPECTION APPROVALS 1 1 � Z z 2 �r/// 3 HEATING 'NSPECTING APPROVALS RE RIGERA N INSP TION APPROVALS i OTHER 2 ----------.----------- 2 --' BOARD OF HEALTH c I""'A & WGRK `SHALL NCT PROCEED 'UNT'L THE PERMIT WILL BECOME NULL AND VOID IF CONSTRUCTION i NSPECTIONS�'N_ ICATED ON THIS CARE. :NSPECTCR AAS APPROVED THE 'iA4!CUS WORK IS NOT STARTED WITHIN S6 MONTHS OF DATE THE CAN BE ,RRANGSD FOR By TELEPHDNi STAGES OF CONSTRUCTION. PERMIT IS ISSUED 6S NOTED ABOVE. OR WRITTEN NOTIFICATION. i .< / O n, Aid 1 �� 2 S�36. F � I „l C V) Q oe 43 t /2- Q o l 9 \ � 7-- s� CERTIFIED PLOT PLAN L O C AT 1 O N: F O R:•L �G-SOGGOLCJ.S /J'LIJEI��o�i�J�•vTCo/L,p. 3 C A L E: �`�=3� � DATE: ��'a• /` /98� . R E F E R E N C E .Q E/A-/G Go T SL /q ti/ Z QL /�iCi9� ,eE��oI20E./J /9T_1gf�/L,vSTA Q�, U >2�G/sT-rr.y a•�.UE�o.s /•� , T E �.�.A�✓l3c�/G �a ��4 E 3 Fs 1 CERTIFY TO THE BEST Of MY KNOWL A66 R G. LAND SUR V YOR AND BELIEF FROM INFORMATION ACQU R E THAT SHOWN ON THIS PLAN IS LOCATED ON THE GROUND AS SHOWN HEREON. � OF � cy JOSEPH r MdNAHAN,JR v No. 13660 SOCIATES PROFE SOIONAL ANDS R ESORS & E GIINEE_RS �gNocistRv�o� su _ T_:_OWN.E _PLA.ZA 900 _ROUT€ I-.34r.SOUT.H _D.ENN.LSr.MA_S._S,. • i t3 t?t r w Aa P ,. f � ,� Q :yak ;.\• `� .. ` . :. . ,, . . . . , .p .. ,. ,: . '� +f;.►'o.c L Est G ` , L 0 r - ' o� •LE'A.0 22, sG ' E-5��'00 I3F,u ay C 7 cD A/ OTC TOPC ; . PET2 PL:x7^/' ay 3AxTetZ v NyE rove . :� LEGEND 3 LI AC4 BUILDING SETBACK REGULATIONS:4PER - EXISTING CONTOUR = --I BUILDING INSPECTOR OR BUILDhNG ORE SD ONTOUR 1 • COMM 'ISSIONER 12 ,C� > .k PROP C --C MIN. FRONT SETBACK 20f EXISTING SPOT ELEVATION li MIN. SIDE SETBACK PROPOSED WATER SERVICE V MI=N. REAR SETBACK / o f TEST HOLE LOCATION GENERAL NOTES: , l) POOL CLEARANCES TO BUILDINGS AND PROPERTY LINES SHALL BE IN -� ACCORDANCE WITH LOCAL AND STATE REQUIREMENTS. • Imperial 2) THIS PLAN DOES NOT INCLUDE POOL LOCATION ON PROPERTY,GRADING, Q � 1wo.f A To: FRor 8 m .Row Toe FTror DTo PRor T To iRoo U IV. D 39 0 Lr C 7e-0 314• 9 lea 31r .A 3e-0 3K Nf ,ra 1!I Nf 27.2 11r FENCING,WALLS OR OTHER SITE INFORMATION. w 2e 11 7? M 30 1• An 1741K An IN 11 1rr P e/,I1r, P 21.41K P 11'.4+K P 2Z-,yr P 7+•-4 1/r P 27.1 Pf 17 n 224 31r 3) ALL CONSTRUCTION SHALL BE DONE IN ACCORDANCE WITH ALL LOCAL �af,d1T1V 2013 °� n ee+Tz n xlvvr n +Maur n 2sa,rr zrd o 10-03W AND STATE REGULATIONS. 9 i —1e +/t -3F-1+ xed 27 R V.-31r R zr.0 3W in i R 1T-+W R 7-6-3 4 R 1V Rf 11'-xW Rf aLI• 4) CONTRACTOR SHALL VERIFY BURIED UTILITIES WITHIN SURROUNDS OF Mountain Pond , aS - Rf +e-++W Rr W R, e- Rr -0+is• s + -+o+a +z4+rr 7R++2W STEEL srAfR cwraw y, INSTALLATION AREA. : 2s4vr a 37-0IW2 Ire a ,ea+rr —W.—,(r )"4 / / WA iff.18 X 30 Left u 3z-0+w• u 111.1,rr U. W-1a r T PART DESCAIP17M PARTS ANSUNSPI-TYPE 0 POOL-NON DIVING r RADIUS PLANPANEL-Br 0"34 s 3Ir-0}• TRAMS SKW^#M PANEL.07 04513 , , , ' • r RADIUS RETURN PANEL-er 0"33 2 1 2 ! - A' 0 r zal�• _ . POOL COMPLIES TO NSPI-S rRAMSPLANPANEL.Tr 04514 1 e ,7.1e 4RR T RADIUS PLAIN PANEL•4-r 04436 i �! 74 1/r 74 1!r ' r RADIUS PLAN PANEL•39 W 04M 1 � \ 9I• � / � F . to REVERSE RAD PANEL-6T 04301-. 1 1 1 i e7R Pf �- ADDITIONAL NOTE - - ' - - 1e REV.RADIUS PANEL-74 Ur 04073 1 1 1 ? Rr r REV.RADIUSPANEL-7+1? 04M 2 2 2 .� . IF POOL IS FURNISHED WITH DRAINS OR SUBMERGED SUCTION OUTLETS, rR.1WSTMSTA� 06166 7 7 9 rR a,3w STM STAR 945zbe t z P e RADIUSI STEP)4tEST 07416RSNt 1 THAN COMPLIANCE TO THE VIRGINIA GRAEME BAKER POOL AND SAFETY NUT•SOLT PAX-7a PAK-75 1 1 n ' 1e+�- 7R 7R ACT IS REQUIRED: N17rrBOLTPAK-1a9 PAK/ao t 1 , a 7 e z+z z z z 11 - 6T » / T R� E F V �, DRAIN COVERS ASME Al 12.19.8 2007 AT 3'-0 :MIN APART AND r nI R ' " ° aH} ENTRAPMENT AVOIDANCE MUST BE INSTALLED. Rr I�TR 7� s ,y . Rr 7R . .� _ 1� Rf 16RR { �TI -eRA01US.PUSTIC STEP OPTION CODE COMPLIANCE _ C D A. MASSACHUSETTS + ar Rie 7+Ur e7' AF V Ric - �-"AIIE BRACE 'COMMONWEALTH OF THE MASSACHU SETTS BUILDING CODE ' Nf780 CMR(8`h ED.) 7 r 4z-N Rr NO DIWNG PERMITTED INTO' 30oI• 1e r B. ELECTRICAL&.PLUMBING ` THIS POOL1.PV 25W P.S.I.ca11P+.bI•P+I1q.Io+nd.nfmprllr,r n4NnmF - . � e -3� . THE CONSTRUCTION AND INSTALLATION OF ELECTRIC WIRING,GROUNDING. 2.e ck=w0cI.+.rm.*»d100ftww n: " 1 7 wilt 00no.b dea Y b a paum!d kwd r 9ddmM ad a aloe. AND BONDING,AND EQUIPMENT ARE SUBJECT TO THE STATE CODE AND TO dr.•b1•..q*rnarPwL 7 e to - lraj- 7 e 7 4.MYnb.Pod CO-Wm r"b to•i.lttl fan.iolm THE CURRENT ADOPTED NATIONAL ELECTRIC CODE REQUIREMENTS. 1 sel ft be•z"+�*1 OfUrAbb MOM a<Nts.e.e BACK BOTTOM SLOPE SHA Low SIDE SOTrw SIDE br ALL PLUMBING MUST COMPLY WITH THE CURRENT ADOPTED STATE CODE: A`*` WALL PAD END v WALL PAD WALL a.A..MT M,rM Woy..Y b E.pwm•nld/A6dud/7 b Cr _ MdNr d4.d"Pal d•d do"drr19a cavIed by l la`•OaMaA"»."°""°a�a4P+•Spy d. ALL DIMENSIONS ARE FINISH DIMENSIONS . e=t.rd*r valou Qa.d oo+1a9.1A1.This YbEA aAfa�irle:.�r rd POOL b dffenuftchmdea�o�aatR rna AA OPM dr_ Q Y1AA149.11 Is b a d"b A omW"d61 ad Ndr4 wb Abcd COPING ` DECK arroPm...a mlmA.N.a.U&P"..�..Ad,%I- _ ` 16?�v"� TM EMEnn owdwsabl+albw =door wtll ctnNM AIdS::4PSp may,-�� aa9a++ae"++�m.>ollard. P00b � a Volume: 112M gal 42550 L, Perimeter. 79'-3' 24.15 m Surface Area: 400.37 ft 2/ 37.19 m2 LInerSq.Ft.: 420.2917 69 ADJUSTABLE I C �•� C'"�t rv1 tot n POOL WALL A-FRAME • . ' PANEL` \ COMPLETE _ , ' . c •;. . 04223 - 2" PREPARED .8"MIN. . BOTTOM ., 2500 psi ��H or MA& G :,�. •1. � CONCRETE ` �. 'f�.. '• ''� BOND BEAM o v> tt, •` _ t �•`:• :. , JAMES A.MARX,JR. ' a r NO-3636WN • /Leo Oslo 'AL ENG 2'-6" _ JM(3 A.MARK Ak OVERDIG / Ada Ptaes ibad F.404,w36365 UNDISTURBED EARTH SO I L LOG DATE WITNESSED BY : c z� i9*7 A -j 0 0.14 L/ T LAANHOLES AND COVER TO BE 13UILT WITHIN 74 44 OF ELE V. TOP FOUNDATION 12" OF F I N ►ISHED GRAD E FINISHED 6 KA I N SLOPE vorf 4%AST I RO cow) OR Pvc s . 40 15 T Yk, I PVC SCH. 40 • PITCH 1�4 FT. a LEVEL", MIN. 2" LAYER A 0 PITCH 112" P E A S TO N E Fjt N V E R I N V E R T D IST. I NVE RT' (L GALLON 40,00 INVERT Box 3/4 1 11.2 SEPTIC TANK — -/,_-�D �, 3,Z INVERT D:'.: YVA 5 H E D 5 T 0 N E U • • A.'D W < ALL AROUND . 0) INVERT C:l 'M C c) 3/4 - VV A 5 H C) ALL L < cl, to uj A I!: D GARBA ,( 7 E LE V. 8 0 T T 0 U E-4 3E R �v MIN.N GRINDER I N D )lLjq0 I� 6�-O�'D I A4,'' OF P IT oom, ?_ 0' MIN. ELEV. 2 7, I:_7 if Z PROFILE OF GROU N D WATER TAB LE 2 ' Al C S A N I T A R Y DISPOSAL SYSTEM NOT TO SCALE DESIGN DATA 47, 5 _lz • CONSTRUCTION OF SANITARY DISPOSAL BEDROOMS DESIGN F L 0 W 3',LD _G AL ./DAY SYSTEM SHALL CONFORM TO MASS. LEACH R A T E MIN. ENVIRONMENTAL CODE TITLE Y (REVISED 7- 1 - 77) MIN./INCH A N D T H E TOWN 0 F Z3,1r-) PROPOSED LEACH CAPACITY . HEALTH REGULATIONS . ? L * SEPTIC TANK., DISTRIBUTION BOX AND LEACHING PITTO BE OF REINFORCED CONCRETE - 4 "4 GAL/DAY MIN. CONCRETE STRENGTH 3000 PSI MIN. STEEL STRENGTH 2 QO 0'9P S I H 10 DESIGN LOADING 0 DRIVEWAYS NOTTO BE LOCATED OVER SYSTEM A/ 0 I=- 7- 0 P 0 pct2 p I- -r ig i "'J<Z UNLESS H - 20 DESIGN LOADING IS USED. 7/,,/ oz- * ALL PIPES AND FITTINGSTO BE WATERTIGHT AND TO BE OF CAST IRON OR SCHED 40 P.V. C. 7'�9 SITE PLAN SHOWING PROPOSED CONSTRUCTIONS H OF _.L S HS. LEGEND L 0 C A T 1 0 N: i3 /,v 7 1 . Z_- V) FOR : 4- 4, APPROVED -- 19 SCALE: DATE : Z I P,Zs BOARD OF HEALTH BUILDING SETBACK REGULATIONS PER EX ISTI NG CON TOU R - --16--- R E F E R E N C E: � 7- 4 f-, s ;`/ rJ 1/1/',/ BUILDING INSPECTOR OR BU ( I_ DfNG PROPOSED CONTOUR a DATE AGENT COMMISSIONER 7Z� 10 MIN. FRONT SETBACK 20 ' EXISTING SPOT ELEVATION 17. 6 PROPOSED WATER SERVICE _W_ MIN. SIDE SETBACK TEST HOLE LOCATION MIN. REAR SETBACK CIVIL IV L C . R . SHORT, INC . No. 27483 �C PROFESSIONAL LAND SURVEYORS L ENGINEERS /OtIAL 1586 MAIN STREET (RTE. 6A) EAST DE NN IS, MASS. 02641